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Coding and Billing

Coding and Billing

Coding and Billing
Coding and Billing Essay
Understanding the complex process of accurate coding and billing is essential to a sustainable practice. As NPs, we are ultimately responsible for ensuring all coding and billing is accurate for each patient seen. For this Discussion, you will search the health care literature and summarize a peer-reviewed journal article published within the last five years.

To prepare: following topic:

Applying for Medicare and Medicaid Provider Numbers

Conduct a search and select a peer-reviewed journal article published within the last five years related to the topic you selected.Coding and Billing Essay

Note: For this Discussion, all students are to avoid all written work, which reviews or outlines coding and billing at previous or current worksites as well as previous or current practicum sites.


By Day 3

Post a brief summary of the article you selected. Include the key reimbursement issue addressed and how they would impact the NP in a collaborative practice versus and independent practice. Discuss an ethical or legal implication(s) associated with your article.

Article Analysis: Coding and Billing

The Healthcare revenue cycle is supported by medical billing and coding. These processes ensure that care providers are reimbursed by the patient for the services offered(LaPointe, 2018). Nonetheless, the processes of billing and coding are separate from one another. Medical coding deals with the extraction of billable details from the clinical records of the client(LaPointe, 2018). On the other hand, medical billing involves the creation of bills and insurance claims using those codes(LaPointe, 2018). Therefore, the two processes intersect with each other at the point of creating medical claims. This paper will summarize a peer-reviewed journal article about medical coding and billing, the key reimbursement issue, and the impact of these issues on the NP who are working in a collaborative practice versus those in independent practice. The paper will also address ethical or legal implications, which are associated with the selected article.Coding and Billing Essay

Article Summary

The article “Billing and upcoding: What’s a doctor-patient to do?” presents a case scenario of Dr. TH, who is a retired dermatologist. Dr. TH visits multispecialty health care organizations twice a year for the management of her hypertension and hypercholesterolemia(Grant-Kels, Kim & Graff, 2016). Additionally, her non-melanoma skin cancers and numerous actinic keratoses necessitate a regular visit to a dermatologist. Both her specialists handled her well any time she visited their clinics. Nonetheless, Dr. TH was concerned with both billing and coding processes associated with her visits. Both specialists coded her almost all her visits, which lasted for about 10 minutes as coded as “99214” (Grant-Kels et al., 2016).A nurse checked her blood pressure level during the internist visit. Additionally, her latest cholesterol studies were reviewed by a doctor. The doctor also palpated for pulses and auscultated both her heart and lungs during the visit. Dr. TH was comfortable with medications that her specialists prescribed for her. Her sun-exposed was checked by her dermatologist during the visit.

Being concerned with the medical coding process, Dr. TH decided to enquire more about this practice from the practice manager of the group. According to the manager, all patients who sought their medical services were billed as “99214” (Grant-Kels et al., 2016). Upon enquiring about the duration of visits and the level of medical examinations, the manager revealed that all clients were coded in the same manner irrespective of the complexity of their conditions. Consequently, Dr. THconsidered this mode of coding as unethical, thus necessitating for some measures to be taken.Coding and Billing Essay

The Impact of the Major Reimbursement Issue addressed on the NP in a Collaborative Practice versus and Independent Practice

The major reimbursement issue discussed in this article involves upcoding. This issue is likely to affect nurse practitioners working in collaborative practice more than those in independent practice. In collaborative NP practice, a group of healthcare practitioners from various professional fields work together with patients, their caregivers, family members and friends, and the entire communities during care delivery(Morley & Cashell, 2017). Working together with these support enhances the quality of care delivered to the patient. Upcoding is likely to have a significant impact on nursing practitioners working in collaborative practice. Coding issues are likely since various practitioners are involved in the delivery of care services. Additionally, the support groups are likely to raise concerns regarding upcoding. In some cases, they might opt to seek healthcare services from another medical facility if they do not get a proper explanation for the upcoding.

On the other hand, independent NP practice involves the provision of healthcare services by a nurse practitioner without supervision from a physician. In this case, a nurse practitioner can evaluate, diagnose, and prescribe medication to a patient just like a physician would do.However, despite improving the overall outcomes of the healthcare sector, independent NP practice is experiencing various challenges(Ortiz, 2018). Although anNP in independent practice is less likely to be affected by the issue of upcoding. By doing all the activities alone, an NP in this setting is likely to code appropriately for the patients. In this case, no confusion is likely to arise during the process of coding. Coding and Billing Essay

Ethical and Legal Implication

This article is associated with a major ethical concern. Notably, the dermatologist engaged in fraudulent billing (Grant-Kels et al., 2016). According to the American Academy of Dermatologyprofessionals (2016), professionals are not supposed to be involved in either fraudulent coding or billing during their practices. Therefore, the dermatologists acted against this code of conduct by issuing the patients with billing codes, which portray relatively high levels of complexity or service or complexity compared to what the client required. Additionally, the article is associated with one key legal issue; fraudulent billing (Grant-Kels et al., 2016). According to legal policies, practitioners should not engage in fraudulent billing. Therefore, engaging in fraudulent billing is acting against the set legal measures.

In conclusion, the article presents issues facing coding and billing in the healthcare sector. According to the case scenario, the dermatologist was involved in upcoding. All Dr. TH’s visits were coded as “99214,” and the length of every service was around 10 minutes. This coding issue is both unethical and illegal. The American Academy of Dermatology professionals is against any form of fraudulent billing. Additionally, it is considered illegal to engage in fraudulent billing. The issue of fraudulent billing is likely to have a higher impact on NP in collaborative practice than those in independent practice.Coding and Billing Essay



American Academy of Dermatology Professional. (2016). Code of Ethical Standards for Dermatologists. American Academy of Dermatology Association. Retrieved from https://www.aad.org/Forms/Policies/Uploads/AR/1.%20Professional%20and%20Ethical%20Standards%20for%20Dermatologists%202012.pdf

Grant-Kels, J. M., Kim, A., & Graff, J. (2016). Billing and upcoding: What’sa doctor-patient to do? International journal of women’s dermatology, 2(4), 149.

LaPointe, J. (2018). Exploring the Fundamentals of Medical Billing and Coding. Xtelligent Healthcare Media. Retrieved from https://revcycleintelligence.com/features/exploring-the-fundamentals-of-medical-billing-and-coding

Morley, L., & Cashell, A. (2017). Collaboration in health care. Journal of medical imaging and radiation sciences, 48(2), 207-216.

Ortiz, J., Hofler, R., Bushy, A., Lin, Y. L., Khanijahani, A., & Bitney, A. (2018). Impact of nurse practitioner practice regulations on rural population health outcomes. In Healthcare (Vol. 6, No. 2, p. 65). Multidisciplinary Digital Publishing Institute. Coding and Billing Essay

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